Comorbid Substance Abuse and Mental Illness

Abstract

Literature concerning assessment and treatment of comorbid substance abuse and mental illness is reviewed. Currently, comorbidity is under-diagnosed and dually diagnosed clients are under-served. Those clients, who are so diagnosed, are most often offered dichotomous parallel or serial interventions. However, research suggests that an integrated approach is preferable. Enhanced training of mental health and substance abuse professionals is urgently needed as is further research concerning the efficacy of various treatment modalities. Improved identification and treatment of comorbidity may reduce the revolving door effect among these individuals and thereby lower health care costs.     

Agency Practices Affecting Social Workers Who Treat Substance-Abusing Clients

Abstract

This study interviewed 115 MSWs with substance abuse training working in general social service agencies to determine if they viewed their settings as facilitating or hindering their work with substance-abusing clients. This study builds on the work of Lightfoot and Orford (1986) who found that social workers were more hindered than helped by their agencies' practices regarding substance-abusing clients.

Results: A majority of workers viewed their agencies as facilitating substance abuse-related work through support from supervisors and administrators, availability of substance abuse training, workers' freedom to choose clients, and opportunities to supervise others on substance abuse-related issues. Supervisor data corroborated these findings. This is a hopeful sign for the profession contrasting with considerable social work literature documenting the profession's historic ambivalence toward substance-abusing clients.     

Estimating the cost impact of three dual diagnosis treatment programs

Specialized intervention programs for people with concurrent severe mental illness and substance abuse reduce the total costs of care. Compared to baseline, cost savings of over 40% were achieved by 18 months, primarily due to significant reductions in the use of acute and subacute mental health services and despite an increase in outpatient mental health services. There also was an observable impact on cost reductions in medical and criminal justice services without an increase in family costs over the same time period.     

Tobacco,Marijuana, and Alcohol Use in University Students: A Cluster Analysis

Abstract

Objective: Segmentation of populations may facilitate development of targeted substance abuse prevention programs. The authors aimed to partition a national sample of university students according to profiles based on substance use. Participants: The authors used 2008–2009 data from the National College Health Assessment from the American College Health Association. The sample consisted of 111,245 individuals from 158 institutions. Methods: The sample was partitioned using cluster analysis according to current substance use behaviors. The association of cluster membership with individual and institutional characteristics was examined. Results: Cluster analysis yielded 6 distinct clusters. Three individual factors—gender, year in school, and fraternity/sorority membership—were the most strongly associated with cluster membership. Conclusions: In a large sample of university students, the authors were able to identify 6 distinct patterns of substance abuse. It may be valuable to target specific populations of college-aged substance users based on individual factors. However, comprehensive intervention will require a multifaceted approach.     

Enhancing Health-Conscious Behaviors Among Clients in Substance Abuse Treatment Programs

The physical health of substance abuse clients significantly deteriorates because of the client’s prolonged abuse of alcohol and other drugs and accompanying behaviors. The purposes of this study are (a) to understand how substance abuse clinicians think about the health needs of their clients, (b) to identify the mechanisms through which clinicians seek to enhance health-conscious behaviors among their clients, and (c) to identify how substance abuse clinicians view their role in enhancing health-conscious behaviors among their clients. A qualitative study was conducted using in-depth, semistructured interviews with substance abuse clinicians (N = 16) from 4 substance abuse treatment centers. Using the theory of planned behavior as a framework for understanding the promotion of health-conscious behaviors in substance abuse treatment, the findings suggest that substance abuse clinicians are capable of enhancing health-conscious behaviors among clients in substance abuse programs.     

Physical Activity as a Helpful Adjunct to Substance Abuse Treatment

ABSTRACT

While limited research exists on the topic of physical activity as an adjunct to substance abuse treatment, a review of relevant multidisciplinary literature indicates a logical rationale for its potential benefits to recovery from addiction. This article provides an overview of common variables that contribute to addictive disease and summarizes the relationship of regular physical activity to improvements on many of these variables. The stages of change from the Transtheoretical Model (TTM, Prochaska & DiClemente, 1982; Prochaska & Velicer, 1997) are described in the context of effectively matching clients in substance abuse therapy to interventions that may include physical activity. Finally, important practical suggestions for implementing physical activity as a useful adjunct to substance abuse treatment are provided.     

Disability and Abuse in Relation to Substance Abuse

Abstract

This analysis reviewed five years of a state's substance abuse treatment admissions and discharges in order to identify specific patterns among persons who had a disability. Using a series of group comparisons, Chi-squares, and logistic regressions, specific patterns of violence and abuse to this population were identified. Results indicate that persons who had a disability and abused substances were more likely to be victimized by physical abuse and domestic violence when compared with their peers without a disability. A person with a disability had about one-half to one-third the odds of receiving long-term residential, short-term residential and intensive outpatient care when compared with persons without a disability.     

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

Need-service matching in substance abuse treatment: Racial/ethnic differences

This study examines the impact of ancillary health and social services matched to client needs in substance abuse treatment for African Americans, Latinos and Whites. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3142 clients (1812 African Americans, 486 Latinos, 844 Whites) from 59 treatment facilities. Results show that racial/ethnic minorities are underserved compared to Whites in the substance abuse service system. Different racial/ethnic groups come into treatment with distinct needs and receive distinct services. Although groups respond differentially to service types, substance abuse counseling and matching services to needs is an effective strategy both for retaining clients in treatment and for reducing post-treatment substance use for African Americans and Whites. Receipt of access services was related to reduced post-treatment substance use for Latinos. Study findings are relevant to planning special services for African Americans and Latinos.     

Validating the Psychosocial Weil-Being Scale (PSWS) with Community Clients

Abstract

Brief, reliable and valid multidimensional tools are needed for routine assessment and evaluation by case managers and other practitioners working in community support programs with clients who abuse alcohol and other drugs. The Psycho-Social Weil-Being Scale was developed as part of a survey of two hundred and ninety-seven community clients for whom case managers assigned psychosocial ratings based on multiple sources of clinical data. Confirmatory factor analysis demonstrated good initial construct validity for the two-factor scale (psychological and social well-being), good internal consistency ratings, and good evidence of concurrent validity with substance abuse indices and other psychiatric indicators. Implications for further development and application of the scale are discussed.     

Spiritual Mechanisms Underlying Substance Abuse Behavior Change in Faith-Based Substance Abuse Treatment

ABSTRACT

Despite increasing interest in “faith-based” substance abuse treatment and HIV risk reduction interventions, there is little systematic evidence of the efficacy of explicitly spiritual interventions. However, fundamental to effective interventions is an explicit conceptualization of mechanisms underlying behavior change. This paper discusses the definition of faith-based organizations, specifically as they relate to substance abuse treatment programs, briefly reviews relevant behavior change theories to identify key variables underlying change, presents an integrative conceptual framework articulating linkages between spiritual intervention components, behavior change processes and substance abuse outcomes, and discusses how the mechanisms identified in our model can be seen in commonly used substance abuse interventions. Overall, the paper suggests that what happens in “faith-based” programs may not be so different from processes taking place in good social work practice in the addictions field.     

Comorbid Substance Use and Mental Disorders Among Offending Youth

ABSTRACT

This study examines the offense, substance use, and mental illness characteristics for a subset of adolescent juvenile detainees receiving services through a federally funded system of care initiative. Findings indicate that 65% of these youth were comorbid for both mental and substance use disorders. Female detainees were at greater risk on almost every measure of mental health impairment and dual substance use and mental disorders. Study results highlight the need for effective, integrated treatment models that can serve youth involved in multiple child-serving systems, and address the challenging constellation of comorbid conditions faced by many juvenile offenders.     

Substance abuse by men in partner abuse intervention programs: current issues and promising trends

This article discusses key studies linking intervention for co-occurring substance abuse and partner abuse. Findings are grouped into three areas: (a) the effect of addictions treatment on partner violence; (b) application of transtheoretical, motivational, and culturally focused approaches to improve engagement and prevent attrition; and (c) assessment-based matching of services. Finally, the relative value of serial, coordinated, and integrated substance abuse programs and partner abuse intervention programs are considered. We reached three primary conclusions: (a) Addiction treatment alone reduces the risk for future domestic violence in a subset of men who batter, (b) screening and assessment for substance abuse by all men in partner abuse intervention programs is a standard of practice but needs to extend beyond "intake" and occur periodically, and (c) coordinated and integrated substance abuse and domestic violence programs probably offer more safety than traditional serial substance abuse treatment followed by partner abuse intervention.     

Benefits and costs associated with mutual-help community-based recovery homes: The Oxford House model

We used data from a randomized controlled study of Oxford House (OH), a self-run, self-supporting recovery home, to conduct a cost-benefit analysis of the program. Following substance abuse treatment, individuals that were assigned to an OH condition (n = 68) were compared to individuals assigned to a usual care condition (n = 61). Economic cost measures were derived from length of stay at an Oxford House residence, and derived from self-reported measures of inpatient and outpatient treatment utilization. Economic benefit measures were derived from self-reported information on monthly income, days participating in illegal activities, binary responses of alcohol and drug use, and incarceration. Results suggest that OH compared quite favorably to usual care: the net benefit of an OH stay was estimated to be roughly $29,000 per person on average. Bootstrapped standard errors suggested that the net benefit was statistically significant. Costs were incrementally higher under OH, but the benefits in terms of reduced illegal activity, incarceration and substance use substantially outweighed the costs. The positive net benefit for Oxford House is primarily driven by a large difference in illegal activity between OH and usual care participants. Using sensitivity analyses, under more conservative assumptions we still arrived at a net benefit favorable to OH of $17,830 per person.     

Transforming Into Men Who Matter: Increasing Empathy in Domestic Abuse Treatment

ABSTRACT

Men referred to domestic abuse treatment are typically involuntary clients, ranging from being legally mandated to being under significant pressure from others to attend. Such treatment programs have mixed results in achieving change in abusive behaviours. Most programs emphasise taking responsibility for abusive behaviour by examining the precursor thinking beliefs and values, with less attention paid to learning new interpersonal skills that replace antisocial behaviours with prosocial alternatives. Empathy provides a measurable moderator of moving beyond simply acknowledging responsibility for past abuse into learning and applying prosocial relationship enhancement skills with their treatment cohort, families, and significant others. This paper describes a program that builds empathy skills through a series of program and mentalisation tasks that include routine client feedback using the Partners for Change Outcome Management System (PCOMS). Evidence of increased retention and statistically significant changes in empathy using the Social Empathy Index are provided from a previous study examining the same program. The practice and research implications for domestic abuse clients and other involuntary populations are discussed.

IMPLICATIONS

• Involuntary clients continue to have high dropout rates across a range of client populations and are a challenge to engage in the change process. With the application of the client feedback tools and relationship enhancement skills described in this paper professionals can more effectively engage other types of involuntary clients in their change efforts.

• The focus on empathy and relationship enhancement skills can lead to reduced treatment dropout across involuntary client populations referred for substance use, domestic violence, or other offender behaviours.

     

Substance Abuse among African-American Children: A Developmental Framework for Identifying Intervention Strategies

Abstract

Substance abuse has devastating effects on the lives of African-American children and adolescents who are both directly and indirectly victims of this problem. This article discusses child and adolescent substance abuse from a psychosocial developmental perspective within an Africentric paradigm. The authors explore contributing and intervention factors related to substance abuse that impact developmental milestones. They delineate preventive tactics for addressing the problem of substance abuse and delineate implications for social work practice.     

Socioeconomic evaluation of a correctional programme in Sweden—long-term effects Samhällsekonomisk utvärdering av ett kriminalvårdsprogram i Sverige—långsiktiga effekter

The present article focuses on the long-term socioeconomic outcome of a correctional programme in Sweden, called KrAmi (n=62), using a systematic comparison with a control group of probation clients (n=51). The evaluation, which had a quasi-experimental design, was based on actual costs for each client (n=113) for a period of five years, from 1995 to 1999. The follow-up period was two years, during which the socioeconomic costs decreased step-wise for both groups, probation groups more so than programme groups. The deteriorations were 70–80% compared to the period before treatment. Rehabilitation to labour market, measured in pension points, was more successful for programme groups than for control groups. Thanks to this, as well as lower costs during the treatment period, the programme groups’ socioeconomic profitability, measured with a 15-year cost–benefit analysis (CBA), was greater than that of the control groups. The cost–effectiveness analysis (CEA) shows that the KrAmi groups are better off in work rehabilitation, depreciation time (one year compared with two and a half years for probation groups) and repayment ratio (14 SEK compared to 6 SEK for probation groups) although cost savings are greater for probation groups.     

Post-Modern Ideas in Substance Abuse Treatment

ABSTRACT

This article describes the use of post-modern ideas in the treatment of substance abusers at a long term residential and day treatment center. It describes some of the changes that ensued as a result of a transformation from a “therapeutic community” (TC) model to a “solution-focused” model. The TC is a deficit model that focuses on a person's flaws and weaknesses. Solution-focused therapy, on the other hand, focuses on what a person has done and is doing right and his or her strengths, assets, and resources. This approach not only improves the quality and effectiveness of substance abuse treatment for clients, but also creates a better working environment for staff.